Nursing and Communication Processes Quiz

Three intervention modes in transcultural nursing. Preservation focuses on maintaining cultural practices and beliefs. Accommodation adjusts care to incorporate cultural elements. Restructuring aims to modify harmful or unhealthy cultural practices.

Levine's theory emphasizes the unity of the individual and focuses on conservation of four aspects: energy, structural integrity, personal integrity, and social integrity.

Neuman's model views nursing as managing stress and promoting stability in individuals. Stresses are categorized as intrapersonal (within the individual), interpersonal (between individuals), and extrapersonal (external factors).

Orem's theory focuses on self-care, which are activities individuals perform to maintain well-being. It defines three nursing systems: Wholly Compensatory (nurse does everything), Partly Compensatory (nurse assists), and Supportive-Educative (nurse teaches).

Peplau's psychodynamic model emphasizes the therapeutic relationship between nurses and clients. It identifies four phases: orientation (setting the stage), identification (building trust), exploitation (working together), and resolution (ending the relationship).

Rogers' theory views the person as a unified energy field, greater than its parts. This energy field interacts with the environment, behaves as a whole, creatively participates in change, and displays unique patterns.

Communication that involves words, either spoken or written.

Communication that uses gestures, facial expressions, posture, body movements, physical appearance, eye contact, and tone of voice.

The person who creates and delivers the message.

The content of the communication, which can include verbal, nonverbal, and symbolic language.

The person who receives and understands the message.

The method used to convey and receive messages, such as visual, auditory, or tactile senses.

The message sent back by the receiver to the sender, indicating understanding or reaction to the original message.

The client's chart, a permanent record of their information and care progress.

A method of organizing and recording client data, making information readily accessible to all health care team members.

Contains all information about the patient when they first enter the health agency. It includes nursing assessment, physician's history, and social and family data.

Lists all the aspects of the person's life requiring health care. Problems are listed in the order they are identified and continually updated.

Made with reference to the active problems and generated by the person listing the problem. It includes initial orders or plan of care.

Includes nurses' narrative notes, which may follow formats like SOAPIE, SOAPIE, or SOAPIER. It documents progress and interventions related to patient care.

Ensures accuracy by recording facts and observations rather than opinions or interpretations.

Each recording in nursing notes is signed by the nurse making it, including name and title (e.g., Ralf Jake M. Faustino RN).

Use of accepted terminology ensures consistency and clarity in documentation. Only commonly accepted abbreviations, symbols, and terms specified by the agency should be used.

When recording a mistake, draw a line through it and write 'mistaken entry' above or next to it, initialing the correction. Don't erase or use correction fluid. Each line should be complete, and if a blank space exists, draw a line through it and initial.

Information in client records should be complete and accurate, including any instances where care was refused.

Documentation should be concise and only include information relevant to the client's health and care.

Documentation serves as a legal record, so accuracy and completeness are essential for protecting both the client and the healthcare team.

Client information should be shared only with healthcare professionals directly involved in their care.

Transfer reports summarize a client's health status and care needs when transferring to another unit.

Telephone reports are used to share urgent client information. They must include the date, time, sender, receiver, subject, and a clear indication of the information received.

Telephone orders are only received by registered nurses. They are repeated back to the physician, documented, and any unusual orders are questioned.

A highly structured interview where the nurse controls the conversation, asking closed-ended questions to gather specific information. Used in situations where you need precise data, like emergencies.

An interview where the client leads the conversation, sharing freely their thoughts and feelings in response to open-ended prompts. Allows for deeper understanding and trust.

The initial stage of an interview where you establish rapport and a sense of understanding with the client. It sets the tone for the entire interaction.

The heart of the interview, where the client provides information through verbal responses to your questions. It's the core of the data-gathering process.

The ending of the interview, where you conclude the conversation and summarize key points. It provides closure and reassurance.

The process of organizing and grouping related information from an interview, often using a written or electronic format. Makes the data easier to understand and analyze.

Double-checking and verifying the accuracy of collected information. Ensures the information used for care planning is reliable.

Thorough and precise documentation of all information gathered about a client's health status. This serves as a crucial foundation for the entire nursing process.

A statement of the client's potential or actual alteration of health status. It is a statement that concisely captures the client's health problem based on analysis of the information gathered during the nursing assessment.

The most common and comprehensive format. It includes the Problem, Etiology, and Signs and Symptoms that define the health problem. It tells us what is going on, why it's happening, and how it shows up.

Identifies a client's health problem with the potential for complications. It reflects a condition that requires ongoing assessment by the nurse, working in collaboration with other healthcare professionals.

A problem that is actually happening at the time of assessment. It's supported by signs and symptoms observed in the client.

The 'why' behind the problem. It's the contributing factors or causes that contribute to the client's health problem. It explains the link between the problem and other factors.

The specific evidence or clinical manifestations that support the nursing diagnosis. They are the observable cues or behaviors that confirm the presence of the problem.

The part of the nursing diagnosis that describes the client's response to a health problem. It describes the actual or potential issue.

A simplified statement that only includes the NANDA label, describing the client's problem or health issue. It provides a focused overview of the client's condition.